Introduction
If a casualty has a head wound, be alert for a possible skull fracture. An affected casualty may have impaired consciousness.

A skull fracture is serious because there is a risk that the brain may be damaged either directly by fractured bone from the skull or by bleeding inside the skull. Clear fluid (cerebrospinal fluid) or watery blood leaking from the ear or nose are signs of serious injury.

Suspect a skull fracture in any casualty who has received a head injury resulting in impaired consciousness. Bear in mind that a casualty with a possible skull fracture may also have a neck (spinal) injury and should be treated accordingly.

Considerations:
Skull fractures may occur with head injuries. Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull. It may be accompanied by injury to the brain.

The brain can be affected directly by damage to the nervous system tissue and bleeding. The brain can also be affected indirectly by blood clots that form under the skull and then compress the underlying brain tissue (subdural or epidural hematoma).

A simple fracture is a break in the bone without damage to the skin.

A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.

A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.

A compound fracture involves a break in, or loss of, skin and splintering of the bone.

Causes:
Head trauma
Falls, automobile accidents, physical assault, and sports



Although the skull is tough, resilient, and provides excellent protection for the brain, a severe impact or blow can result in fracture of the skull and may be accompanied by injury to the brain. Some of the different types of skull fracture include:

Simple: a break in the bone without damage to the skin

Linear or hairline: a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone

Depressed: a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain

Compound: a break in or loss of skin and splintering of the bone. Along with the fracture, brain injury, such as subdural hematoma (bleeding) may occur.

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